Diagnosis and management of residual products of conception following incomplete first trimester abortion

Purpose of review To review current evidence around suspected residual products of conception (RPOC) following first-trimester induced and spontaneous abortion, and to find a balanced approach to management centering patient safety, autonomy, and satisfaction without overdiagnosis and unnecessary treatment. Recent findings There continues to be no accepted endometrial thickness or appearance that is diagnostic for RPOC. Increasing the duration between abortion and evaluation for RPOC decreases unnecessary intervention in stable patients. Medication treatment for RPOC results in greater blood loss and a greater need for procedures, with a lower spontaneous completion rate, compared with expectant management. Despite potentially lower rates of intrauterine adhesion formation, hysteroscopy confers no future reproductive outcome benefit compared with suction dilation and curettage in the treatment of RPOC. Uterine artery embolization with more rapidly canalizing agents may mitigate some of the risks while preserving immediate efficacy. Summary RPOC is often treated based on the ultrasound appearance of the endometrium after first-trimester abortion, which has poor predictive value for RPOC. The clinical presentation should drive the management, and expectant management has an extremely high rate of abortion completion in stable patients.